As he waits for a doctor in the ER at Temple University Hospital, Romualdo Rivera stares at the ceiling, holding his side with one hand.
His face brightens when Carmen Diaz, dressed in yellow scrubs like Temple’s other medical interpreters, begins translating for Dr. Jason Bell.
“How does it feel? Is it crampy? Dull? Sharp?” Bell asks.
“Que tipo de dolor es?” Diaz says. “Siente calambres en el estomago? Es un dolor leve o agudo?”
Rivera, an elderly man who declines to give his age, replies in Spanish.
“It’s like a headache pain; a dull, achy pain,” Diaz translates.
The Q&A continues as Rivera’s blood pressure is taken, his pulse checked, his respiration monitored. Where is the pain? Does it hurt to breathe? Any fever? Chills? Palpitations?
Bell concludes that the problem isn’t Rivera’s heart but his stomach. X-rays, blood work and a CAT scan are ordered.
Without interpreters, Bell says later, doctors must resort to “a lot of pointing and charades.”
“It’s very difficult to get an adequate (medical) history from patients who don’t understand what they’re being asked,” he said. “When we can home in on whatever the problem is, it makes it easier to provide the proper treatment, and it cuts down on unnecessary testing.”
Diaz, 27, has worked as an interpreter at Temple since April, but it’s a job she has been doing most of her life.
“I know what it’s like to be 9 years old and to be interpreting for people,” she said.
Cultural training also is an important part of the Temple program.
“Lots of cultures believe in the evil eye and that staring at a baby can bring harm to it,” said interpreter Jaime Molyneux, who works in maternity services at Temple. “Some people also get upset if you touch the baby’s feet, because they believe it can stunt their growth or cause a stutter.”
Modesty or gender roles also come into play — some women are wary of divulging personal information or undergoing exams by male gynecologists, for example. And attitudes on breast-feeding and circumcision vary widely.
After giving discharge instructions to one young mother, the 27-year-old Molyneux is called to translate for Veronica Diaz, a Mexican immigrant who has had a rough night after giving birth to her son, Roberto.
“Is it inflamed? Because I seem to have a lot of stomach,” Molyneux translates from the new mother to Dr. Valentino Piacentino III.
Piacentino assures her that the swelling is typical and will go down.
“It’s really simple: If I don’t have Jaime, it just doesn’t work,” Piacentino says later. “In medicine, communication is everything. If I don’t have a way to communicate with patients, I can’t do much.”
'Who pays for it?'
Since 2000, hospitals and private practices getting federal funds have been required to provide interpretation services under the Civil Rights Act. They’ve largely made do since then with untrained or undertrained people.
“For so long the myth has been that you could get by using friends, family members, staff; now there’s growing understanding that that’s not enough,” said Sala, at UC Davis.
“We know what should be done, but the big issue is who pays for it? That question has not been answered.”
Professional medical interpreters can earn $20 to $25 an hour.
Dr. Ricardo G. Unda, director of Temple’s program, said it seems intuitive that the presence of interpreters would improve care and save money in the long run. But little hard data exist. Research suggests the more non-English-speaking patients you have, the higher the risk for error and poorer health care.
A small study published last year in the journal Pediatrics found that mistakes in interpreting were common, with 31 errors on average in each of 13 recorded doctor visits. About 22 percent of people with untrained interpreters, such as family or friends, had interpretation errors of potentially serious medical consequence during the visit, compared with 12 percent for those with a staff interpreter.
Professional, trained interpreters were found at fewer than one-fourth of hospitals, and most of that group had not received training in medical terminology.
The National Council on Interpreting in Health Care reports that many people who consider themselves bilingual are unable to pass the council’s basic proficiency tests.
As Temple interpreter Diaz puts it: “To speak Spanish at the dinner table with your family is one thing. To speak in Spanish about gastrointestinal disorders is another thing."
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